Path of Medicine With a System

The three major complications of fractures are infection, osteofascial syndrome, and nonunion. One is more terrible than the other, the first two are short-term complications, and the latter is long-term complications. If there is no postoperative follow-up, until the symptoms appear, the situation is already serious.

In the orthopedic operating room in the early morning, Zhang Fan looked at the patient's X-ray and frowned. It wasn't that the operation was difficult, but that he couldn't feel the transparency of liver tumors.

Orthopedics is the earliest discipline that Zhang Fan came into contact with, and it is also a surgery that he has experienced a lot. Although the surgery is becoming more and more proficient now, there is always no sense of transparency, as if there is something missing.

"What's the reason? Could it be that fewer surgeries have been performed, or that the surgeries are not difficult enough?" Zhang Fan's brows remained frowned, and no one else dared to bother him.

In fact, this matter is very simple. Wherever there is oppression, there is resistance. As long as you are not overwhelmed, you will definitely sublimate and break through. Although liver tumor surgery is not the most difficult surgery, it is not easy either.

The risk of surgery for huge liver tumors is even greater. Zhang Fan worked hard to apply knowledge and think hard.

Suddenly, the knowledge of the liver was forcibly broken through. On the contrary, it is a simple orthopedic surgery. The more you do it, the more proficient it becomes, and it becomes a habit, and there is no way to talk about a breakthrough.

"Zhang Yuan, the anesthesia is ready. We are all ready." Zhou Chengfu softly reminded Zhang Fan who was in a daze.

"Oh, all right. Let's start." Zhang Fan put down his thoughts as if he had just woken up, and concentrated on starting the operation. So far, the medical community has not yet unified the definition of nonunion.

Zhang Fan believes that within three months, if the fracture ends cannot heal without intervention and treatment, it should be called nonunion. Because of Zhou xx's diabetes, and Chen Qi wanted to make the surgical x-rays look better, so he stripped off too much estimated soft tissue.

Moreover, the patient was still smoking, drinking, and did not exercise properly, which eventually led to nonunion. At this time, the disconnection of the middle end of his humerus had shrunk, forming a large amount of granulation.

The human body is so strange. If normal tissues cannot grow in normal places, abnormal tissues will grow. If detected a few months later, the atrophy can be exacerbated due to the disuse of the bone.

Pseudo-joints will appear in a short period of time. A normal arm has only one elbow joint. Because of the pseudo-joint at the stump, his arm becomes a three-section stick.

If the time is prolonged, it will be like an infection, and the original normal bone will begin to shrink, and the final result can only be to shorten the arm. Then it became one with long arms and the other with short arms, leaving behind unchangeable disabilities.

There are many ways to treat nonunion. There are extended steel plates. After the original 5-6 cm steel plate is taken out, the broken end is corrected, bone grafted, and then a longer steel plate is put in to strengthen the stability of the fracture and allow it to recover.

The other is intramedullary nailing. The opening is directly viewed from both ends of the long bone, and the intramedullary nail is placed for fixation.

Another option is external fixation. Just like building a building, a steel frame is erected outside the fracture to fix it.

Because Zhou xx's fracture ends have not shrunk very far, Zhang Fan plans to use an extended steel plate to fix it. Each of the three fixing methods has its own advantages, there is no best, only the most suitable.

After the incision, Zhang Fan continued to insert the knife into the original incision. There was no way to talk about the hierarchical structure of this second operation, because of the operation, the adhesion around the incision was severe.

Zhang Fan entered while observing the two assistants. The two cooperated with Zhang Fan very skillfully. After the incision was opened, black silk threads that had not been absorbed continued to appear, some were long and some were short.

Although this kind of thread can be absorbed, if it is found, it should be removed as much as possible, after all, the thread ends are considered foreign objects. Silk thread absorption, there is a joke in the medical world that is not a joke.

It is said that in the early years, the country's technology was poor, and the silk thread materials used were not up to standard. Thirty years after a person underwent appendix surgery, a black thread could still grow on a certain part of the body.

When the muscle was opened, the steel plate had been wrapped by hyperplastic granulation tissue.

What is the situation? It’s like a steel plate is placed on a plaster mold, and the plaster mud overflows after being pressed. This calcified granulation tissue surrounds the steel plate attached to the bone.

"Neiliu's steel nail." Zhang Fan said to the nurse after taking a look. The screw heads of orthopedic steel nails used to have plum blossoms and crosses.

Once this type of screw is uncomfortably hard, the screw head will have a gap, and it will not be able to bite when it is taken out. That is to say, there is an unwritten rule in orthopedics.

Whoever installs the steel plate will get it! With a lot of complaints from orthopedic surgeons, this kind of plum blossom and cross screw has gradually withdrawn from the clinic. steel nails.

After unscrewing the steel nails, Zhang Fan directly bit the steel plate with two Alice pliers, pulled hard, and the steel plate was pulled out from the calcified granulation tissue.

The instrument nurse looked at Zhang Fan holding the Alice forceps to remove the steel plate, gritted his teeth and said nothing. If this were other resident doctors or general attendings, the little nurse would have been displeased.

The operation is under the control of the doctor, but the equipment is under the control of the nurse. And because of the violence of orthopedic surgeons, doctors in other departments are very reluctant to use the equipment used by orthopedic surgeons.

The pliers clamp the bone and the steel plate. After a few times of clamping, the very brand-new instruments can no longer be used, and there is no way to forcefully suture even with a suture needle.

Pull out the steel plate. "Bone knife!" Zhang Fan asked for the bone knife and began to remove the calcified cartilage tissue on the surface of the bone, as if a bony steel plate was embedded on the surface of the bone.

If the density of calcification is relatively high, it is not enough to rely on a bone knife, and a hammer is required. Just like chiseling a stone, the calcification on the bone is removed one by one.

This operation must be stable and there must be no accidents. Once slippery, the kinetic energy of the hammer strengthens the strength of the doctor's arm, which can definitely break the patient's bones.

"Steel! Steel! Steel!" The sound of the hammer hitting the bone knife rang out in the operating room. And there must be a sense of rhythm, you can't knock randomly, and the time interval between the last time and the next time should be about the same.

Zhang Fan knocked, Zhou Chengfu stretched his fingers and pressed the incision. Because of the vigorous beating, the blood, bone marrow, and fat particles in the wound, following Zhang Fan's beating, were like dancing wildly. Although Zhou Chengfu had already covered the wound with his hands, there were still yellow fat particles eloping out with blood.

The surgical drape was dotted with fat particles and blood soaked in the drape, like a sesame cake, not black sesame, but yellow sesame.

"Curettes! Start taking the bones, don't take too much. Bring the periosteum!" Zhang Fan said to Zhou Chengfu. The bone has shrunk, and there is no way it can heal without a way to connect it.

The bone graft must be cancellous bone with periosteum. Because there are a large number of osteoprogenitor cells on the periosteum, this cell can make the bone develop and grow, and the cancellous bone is like the plug of an old-fashioned thermos bottle after it is dried. There are a large number of voids inside, rich in various growth factors, which can induce bone growth.

There are not many places where there are both periosteum and cancellous bone, and there are even fewer places that can be intercepted. For example, the iliac spine is a very good bone bank.

"Okay." After Zhou Chengfu agreed, he took Xu Xian and moved to the pelvis. If Zhang Fan smashing the bone knife is considered violence, taking the bone is simply violent.

After cutting the skin and pulling away the fat and muscle, Zhou Chengfu gritted his teeth and began to take the bone. The bone knife was placed on the iliac spine, so Zhou Chengfu was wearing a mask. If he didn't wear a mask, he would definitely look hideous at this time.

The hardness of the periosteum and cortex is very high. Following Zhou Chengfu's beating, the whole body of the bound patient shook. It was directly "哐! 哐! 哐!" The blood flowed like a flower. That's it, it's not the most brutal in orthopedics.

A piece of bone was chiseled out by a bone knife, not too big, slightly shorter than Green Arrow Gum, and a bone as thick as a matchbox was removed.

After taking out the bone, Zhou Chengfu began to cut it into pieces with scissors. Zhang Fan is using a curette to clean up the broken granulation tissue. How to describe this thing, it's like digging out a yogurt pot with a spoon.

The calcified granulation tissue is dug with a bone knife, and the white uncalcified granulation tissue is dug with a curette. These things must be cleaned up. If it is not cleaned properly, there will still be residues at the broken end, and the bone will think that this place is fleshy, so new bones will not be sent out.

"Gauze." After Zhang Fan dug it clean, he began to wipe it with gauze. Clearance of granulation tissue must be ensured. After wiping, the broken ends of the fracture at this time are as white as broken ivory chopsticks.

"Zhang Yuan, look, is it enough?" Zhou Chengfu handed Zhang Fan the bone that had been cut into the size of a soybean.

"Not bad, the estimate is good, it should be enough." Zhang Fan boasted to Zhou Chengfu. In the past, Lao Zhou would have scoffed at him, but now, Zhou Chengfu was so happy that his eyes became a line.

Filling, this requires technology. Just like a hollow bamboo is broken, you have to fill the middle with soybeans so that they don't fall down. This is the technique.

Students who were not good at playing with building blocks when they were young could not do well in this matter. Lao Zhou estimated that he had no building blocks to play with when he was young, so he had no choice but to write articles in the end.

First put the broken bone with cortical periosteum as the base, then cancellous bone fills the top bit by bit, and then fill the top with the broken bone with cortical bone and periosteum.

It’s not okay to be loose, because the steel plate needs to be opened with an electric drill. If it is loose, the steel plate has not been installed, and the filled bone has already collapsed.

What is seeing each other, this is seeing each other. After filling the broken ends, you have to forcefully insert them into the gaps with cortical bone fragments. If you want to insert forcefully, you must insert forcefully.

Then, this section of the missing bone is even connected. Then put the steel plate. The humerus is not a very round pipe, because the first time the steel plate was applied, four or five holes were drilled on both sides of the broken end.

The second time the steel plate is put on, you must stay away from these places, otherwise the bone may break when the screw is put on again, so the steel plate that used to be only five or six centimeters long has become a two to thirty centimeters long plate. Like adding a metal shield, it is supported on the humerus.

As the steel plate grows, the incision will of course be extended. For example, the length of the steel plate is 30 centimeters, and the crossing is 20 centimeters even if it is small. Use the retractor to forcibly pull the place covered by the tissue.

It's like opening a person's mouth to the maximum, and then continue to use the metal hook to pull it open until the innermost teeth are exposed.

When the steel plate is installed, the humerus has a slight curvature and is slightly triangular. Therefore, the steel plate must find a surface that can adhere better.

After the steel plate was attached, Zhang Fan began to drill holes. Although doctors in other departments joke about orthopedics and say that a good carpenter can perform fracture surgery, it is actually a joke. Carpenters really can't do this job.

Open holes, this steel plate is a pressurized steel plate. The nail holes on the pressure plate, one of which is a pressure hole, is designed with a slope inside the hole, which looks like an ordinary hole is elongated. The advantage is that it can play the role of pressurization, so that the broken ends of the fracture can be closely combined and the healing can be promoted. The disadvantage is that the pressure hole is the weakest part of the steel plate, which is easy to break.

During the doctor's operation, it is difficult to control the pressure force. If the pressure is too high, it will cause slight osteonecrosis at the stump. If the pressure is too small, it will not work. Because each patient's physique is different, in actual work, it is difficult to grasp the intensity.

With this level of strength, it won't take a few years to master it. Drilling along the pressure hole of the steel plate, Zhang Fan observed the connected bones while drilling.

To be honest, in this kind of surgery, one step forward must ensure the suitability of the original step. If there is a problem with the original step, if it is not corrected, there is no way to get off the operating table.

When Zhang Fan drilled holes, he was very respectful and cautious. Although he inserted it himself, manpower cannot compete with the vibration generated by the electric drill, so Zhang Fan was very careful.

After opening the holes, start screwing. This is also a technical job. Apart from other things, it is very particular about an angle. The verticality of the screw must be guaranteed, and the contact surface with the steel plate bone must be vertical.

How to be sure, feeling! Yes, it is a very unreliable feeling, if the feeling does not come, just wait for slippery silk. There is no problem at all, the screw strength of the upper pressure steel plate, once there is a direction problem in the bite of the screw and the steel plate, the slippery wire will not escape.

Put on the steel plate, start washing, and stitching! When the stitching was about to be finished, Zhang Fan suddenly raised his head and said to Zhou Chengfu and Wang Pingshan: "Which of you will take over this patient?"

Zhou Chengfu hesitated for a while, Wang Pingshan glanced at Zhang Fan, and said directly: "If you don't worry, leave it to me!"

"Okay!" Zhang Fan didn't say much. Zhou Chengfu next to him suddenly wanted to feel that something was moving away from him.

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